
  <form class="usa-form-large">
    <fieldset>
      <legend>Mailing address</legend>
      <label for="mailing-address-1">Street address 1</label>
      <input id="mailing-address-1" name="mailing-address-1" type="text">

      <label for="mailing-address-2">Street address 2 <span class="usa-additional_text">Optional</span></label>
      <input id="mailing-address-2" name="mailing-address-2" type="text">

      <div>
        <div class="usa-input-grid usa-input-grid-medium">
          <label for="city">City</label>
          <input id="city" name="city" type="text">
        </div>

        <div class="usa-input-grid usa-input-grid-small">
          <label for="state">State</label>
          <select id="state" name="state">
            <option value></option>
            <option value="AL">Alabama</option>
            <option value="AK">Alaska</option>
            <option value="AZ">Arizona</option>
            <option value="AR">Arkansas</option>
            <option value="CA">California</option>
            <option value="CO">Colorado</option>
            <option value="CT">Connecticut</option>
            <option value="DE">Delaware</option>
            <option value="DC">District of Columbia</option>
            <option value="FL">Florida</option>
            <option value="GA">Georgia</option>
            <option value="HI">Hawaii</option>
            <option value="ID">Idaho</option>
            <option value="IL">Illinois</option>
            <option value="IN">Indiana</option>
            <option value="IA">Iowa</option>
            <option value="KS">Kansas</option>
            <option value="KY">Kentucky</option>
            <option value="LA">Louisiana</option>
            <option value="ME">Maine</option>
            <option value="MD">Maryland</option>
            <option value="MA">Massachusetts</option>
            <option value="MI">Michigan</option>
            <option value="MN">Minnesota</option>
            <option value="MS">Mississippi</option>
            <option value="MO">Missouri</option>
            <option value="MT">Montana</option>
            <option value="NE">Nebraska</option>
            <option value="NV">Nevada</option>
            <option value="NH">New Hampshire</option>
            <option value="NJ">New Jersey</option>
            <option value="NM">New Mexico</option>
            <option value="NY">New York</option>
            <option value="NC">North Carolina</option>
            <option value="ND">North Dakota</option>
            <option value="OH">Ohio</option>
            <option value="OK">Oklahoma</option>
            <option value="OR">Oregon</option>
            <option value="PA">Pennsylvania</option>
            <option value="RI">Rhode Island</option>
            <option value="SC">South Carolina</option>
            <option value="SD">South Dakota</option>
            <option value="TN">Tennessee</option>
            <option value="TX">Texas</option>
            <option value="UT">Utah</option>
            <option value="VT">Vermont</option>
            <option value="VA">Virginia</option>
            <option value="WA">Washington</option>
            <option value="WV">West Virginia</option>
            <option value="WI">Wisconsin</option>
            <option value="WY">Wyoming</option>
          </select>
        </div>
      </div>

      <label for="zip">ZIP</label>
      <input class="usa-input-medium" id="zip" name="zip" type="text" pattern="[\d]{5}(-[\d]{4})?" data-grouplength="5,4" data-delimiter="-" data-politespace>
    </fieldset>
  </form>

